41–50 of 377 posts
discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing t…
I feel like we are going too far. Central planning in presence of hostile adversaries unrestricted by any ethical systems failed. And by what measures has “free market” has proven itself as successful? You can come up with your measures of success and others will propose measures of shortcoming. Others will even dispute the claim the American-led west is anything different from a centrally planned set of cooperating…
It's not unreasonable given the training investment to err on the side of avoiding wasted education, and fill gaps with less-trained people.
The physician/patient ratio is not a good measure of service availability. Some would say US doctors are more productive.
The alternative is not more doctors, but more "advanced practice" providers - Nurse Practitioners and Physician Assistants (or Associates). Their numbers have increased dramatically, and they have taken over anything routine and many ancillary functions of complex cases. PA schools in particular have proliferated, and produced an over-supply of PA's, who depend entirely on having a supervising physician. NP's by contrast benefit from the long history of unionization in nursing, have taken over management in many cases, and restrict the supply at the school level. Overall they top out at what doctors start at, even with decades of experience. It's good for young professionals, but there's not a lot of headroom.
As for dependence on foreign schools, the US has more foreign graduates in every field, and most have been hired into hospital systems as a way of combating medical practice groups.
The independent medical practice groups almost completely died out, as hospital systems refused to contract out to practices, and instead hired doctors as employees so they could control costs. Recently with private equity targeting specific local monopolies, you're getting specialty practices in radiology, anesthesiology, cardiology (mostly stenting) and now even GI, where the same private equity firm coordinates everyone in a geographical area (and pursues a number of dark-billing practices). There may be small internal practice in the hospital for poor people to get middling care, but the good doctors go into the practice groups.
Access to care comes down to logistics (terrible IT) and PCP's being used to reduce care. They hate it, which is why those who can avoid primary care.
The other side of supply is loss. Doctors are leaving the profession at a high rate because they're not really doing medicine (and they can afford to leave). They need better systems and adjuncts and more sensitive administration.
Earlier quoted context omitted.
I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
If being a doctor is so incredibly hard then why are they allowed to practice after not sleeping for so long?
discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
Surgeons will always need to be extremely highly trained because they do not have the ability to hesitate. Most of healthcare simply isn’t anywhere near the acuity level of surgery.
By far, the biggest need is primary care. The exact opposite of acute. The rigor, effort, and expense of medical school simply doesn’t match modern primary care. Either the system needs to change to accommodate that or physicians are in for a reckoning.
Physician lobbies have a golden opportunity to ensure even higher pay and better product by building better care models. Instead they simple say “fuck your I got mine”
The health care industry seems to be profiting off this by having more care provided by nurse practitioners and physician assistants but billing the insurers same as they would charge for M.D./D.Os.
But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect.
Some states permit NP's to practice without a physician, but PA's all require a supervising physician.
discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
What’s discriminatory about MCATs?
I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttl…
There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor. Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means. So it is up to each person now…
The health care industry seems to be profiting off this by having more care provided by nurse practitioners and physician assistants but billing the insurers same as they would charge for M.D./D.Os.
Medicare and most insurance strictly control this. But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect. Some states permit NP's to practice without a physician, but PA's all require a supervising physi…
“With this move, Iowa joins five states that have removed the legally mandated relationship between physician assistants and doctors, according to the American Academy of Physician Associates.”
Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing t…